2010-2016年新疆地区早中期肺癌患者术后生存及影响因素研究-基于PSM分析
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摘要
目的了解新疆地区手术与否的早中期肺癌患者的生存预后情况,探讨影响肺癌患者预后的因素。方法选择2010年1月-2016年12月新疆医科大学附属肿瘤医院收治的原发性肺癌患者688例,通过倾向性评分方法(PSM)对手术组及非手术组基线资料进行匹配,使组间均衡可比,采用X~2检验比较组间差异,Kaplan-Meier法绘制生存曲线,单因素采用Log-rank检验,多因素采用Cox回归模型。结果最终纳入男性464例(67.4%),女性242例(32.6%),性别比2.1∶1,汉族占大多数(88.7%),平均年龄(62.8±11.1)岁,PSM后基线水平均衡可比。手术组1、3、5年生存率分别为83.4%、54.8%、40.1%,非手术组为63.7%、23.8%、12.7%,2组比较有统计学差异(P<0.001)。单因素及多因素分析显示:性别、民族、年龄、是否手术、是否化疗、T分期、N分期和肿瘤部位是影响肺癌患者预后的独立因素。结论新疆地区早中期肺癌患者手术组的预后明显优于非手术组,男性、少数民族、高龄、低BMI、未手术、未化疗、低KPS、高T分期、高N分期及中央型预后相对更差。
Objective To investigate the survival and the prognosis of Surgical and Non-Surgical Patients with early and middle stage lung cancer in Xinjiang area and to explore the prognostic factors. Methods 688 patients with primary lung cancer admitted between January 2010 and December 2016 in Affiliated Tumor Hospital of Xinjiang Medical University were selected. Baseline data onto the surgical and non-surgical groups were compared by Propensity Score Matching(PSM), in order to achieve comparable balance between the groups. The chi-square test was used to compare the differences between the variable's groups, and the survival curve was plotted by Kaplan-Meier method. Log-rank tested was used for univariate analysis, and Cox regression models were used for various factors. Results The studies eventually included 464 cases(67.4%)of male, 242 cases(32.6%) of female, men-to-female-ratio was 2.1:1, Han ethnicity was dominant(88.7%), and the average age were(62.8 ±11.1) years. After PSM, the basic equilibrium between the groups was comparable. The 1, 3, and 5 years survival rates of the surgery group were 83.4%, 54.8%, and 40.1%, respectively, in the non-surgical group were 63.7%,23.8%, and 12.7%, and two groups were statistically different(P<0.001). Univariate and multivariate analysis showed that gender, ethnicity, age, surgery, chemotherapy, T stage, N stage and tumor site were the independent factors influencing the prognosis of lung cancer patients. Conclusion The survival rate of lung cancer patients in the Xinjiang region with early and middle stage in the surgical group was significantly better than that of non-surgical group. Male, ethnic minorities, advanced age,low BMI, non-surgery, non-chemotherapy, low KPS, high T stage, high N stage and central prognosis were relatively worse.
Objective To investigate the survival and the prognosis of Surgical and Non-Surgical Patients with early and middle stage lung cancer in Xinjiang area and to explore the prognostic factors. Methods 688 patients with primary lung cancer admitted between January 2010 and December 2016 in Affiliated Tumor Hospital of Xinjiang Medical University were selected. Baseline data onto the surgical and non-surgical groups were compared by Propensity Score Matching(PSM), in order to achieve comparable balance between the groups. The chi-square test was used to compare the differences between the variable's groups, and the survival curve was plotted by Kaplan-Meier method. Log-rank tested was used for univariate analysis, and Cox regression models were used for various factors. Results The studies eventually included 464 cases(67.4%)of male, 242 cases(32.6%) of female, men-to-female-ratio was 2.1:1, Han ethnicity was dominant(88.7%), and the average age were(62.8 ±11.1) years. After PSM, the basic equilibrium between the groups was comparable. The 1, 3, and 5 years survival rates of the surgery group were 83.4%, 54.8%, and 40.1%, respectively, in the non-surgical group were 63.7%,23.8%, and 12.7%, and two groups were statistically different(P<0.001). Univariate and multivariate analysis showed that gender, ethnicity, age, surgery, chemotherapy, T stage, N stage and tumor site were the independent factors influencing the prognosis of lung cancer patients. Conclusion The survival rate of lung cancer patients in the Xinjiang region with early and middle stage in the surgical group was significantly better than that of non-surgical group. Male, ethnic minorities, advanced age,low BMI, non-surgery, non-chemotherapy, low KPS, high T stage, high N stage and central prognosis were relatively worse.
引文
[1] Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012[J].CA-A Cancer Journal for Clinicians, 2015, 65(2):87-108.
[2]陈万青,郑荣寿,张思维,等.2012年中国恶性肿瘤发病和死亡分析[J].中国肿瘤,2016,40(1):1-8.
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[4] Pass HI, Carbone DP, Johnson DH, et al. Principles and Practice of Lung Cancer:the official reference text of the International Association for the Study of Lung Cancer(IASLC)[M]. 4th ed. Philadelphia:Lippincott Williams&Wilkins, 2012.
[5]中国临床肿瘤学会指南工作委员会.中国临床肿瘤学会(CSCO)原发性肺癌诊疗指南(2017. V1)[M].北京:人民卫生出版社,2017:29-36.
[6] Hayeck T. Retrospective mixed model and Propensity Score methods for case control data[D]. Harvard:Harvard University, 2015.
[7]孙婷,秦国友,武振宇,等.不同混杂结构条件下各倾向性评分方法的模拟比较研究[J].中国卫生统计,2017,34(3):415-420.
[8] David EA, Cooke DT, Chen Y, et al. Surgery in high-volume hospitals not commission on cancer accreditation leads to increased cancer-specific survival for early-stage lung cancer[J]. The American Journal of Surgery, 2015, 210(4):643-647.
[9] Riquet M, Mordant P, Pricopi C, et al. A review of 250 ten-year survivors after pneumonectomy for non-small-cell lung cancer[J].European Journal of Cardio-Thoracic Surgery:Official Journal of the European Association for Cardio-Thoracic Surgery, 2014, 45(5):876-881.
[10] Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016[J]. CA-A Cancer Journal for Clinicians, 2016, 66(1):7-30.
[11] Zeng H, Chen W, Zheng R, et al. Changing cancer survival in China during 2003-15:a pooled analysis of 17 population-based cancer registries[J]. The Lancet Global Health, 2018, 6(5):e555-e567.
[12] Gu DF, Kelly TN, Wu XG, et al. Mortality attributable to smoking in China[J]. New England Journal of Medicine, 2009, 360(2):150-159.
[13] Islami F, Chen W, Yu XQ, et al. Cancer deaths and cases attributable to lifestyle factors and infections in China, 2013[J]. Annals of Oncology, 2017, 28(10):2567-2574.
[14]张淑娟,常建华,王磊,等.中国新疆维吾尔族人群中肺癌驱动基因的表达[J].中国癌症杂志,2017,27(1):14-19.
[15]刘翔,王秀梅,刘新亚,等.2010年-2014年新疆某院不同民族恶性肿瘤住院病例分析[J].中国病案,2016,17(11):63-65, 96.
[16] Cronin KA, Lake AJ, Scott S, et al. Annual report to the nation on the status of cancer, part I:National cancer statistics[J]. Cancer, 2018,124(13):2785-2800.
[17]陈万青,左婷婷,郑荣寿,等.2013年中国肺癌发病与死亡分析[J].中华肿瘤杂志,2017,39(10):795-800.
[18]张敏璐,吴春晓,龚杨明,等.上海人群肺癌生存率分析[J].中国癌症杂志,2017,27(5):326-333.
[19]郭兰伟,刘曙正,张韶凯,等.中国人群BMI与肺癌发病风险的Meta分析[J].中华预防医学杂志,2015,49(7):649-653.
[20]张翠敏,朱贵东,李全林,等.肺癌生存者生活质量及影响因素分析[J].现代预防医学,2011,38(7):1204-1206.
[21]王丽萍,王剑英,聂芳,等.姑息性化疗对Ⅳ期非小细胞肺癌预后及生存质量的改善作用[J].实用癌症杂志,2018,33(1):63-65.
[22] Drake JA, Portnoy DC, Tauer K, et al. Adding radiation to adjuvant chemotherapy does not improve survival of patients with N2 lung cancer[J]. The Annals of Thoracic Surgery, 2018, 106(4):959-965.
[23]阚强波,王俊峰.手术治疗非小细胞肺癌预后多因素分析[J].实用癌症杂志,2018,33(1):75-78.
[24]李星凯,刘战业,姜运峰,等.原发性中央型和周围型肺鳞癌临床病理学及预后差异[J].山东大学学报(医学版),2017,55(9):73-78.
[2]陈万青,郑荣寿,张思维,等.2012年中国恶性肿瘤发病和死亡分析[J].中国肿瘤,2016,40(1):1-8.
[3] Global Health Data Exchange(GHDx). Default results are deaths and DALYs for 2017 with trends since 1990[EB/OL].[2018-12-11].http://ghdx.healthdata.org/gbd-results-tool.
[4] Pass HI, Carbone DP, Johnson DH, et al. Principles and Practice of Lung Cancer:the official reference text of the International Association for the Study of Lung Cancer(IASLC)[M]. 4th ed. Philadelphia:Lippincott Williams&Wilkins, 2012.
[5]中国临床肿瘤学会指南工作委员会.中国临床肿瘤学会(CSCO)原发性肺癌诊疗指南(2017. V1)[M].北京:人民卫生出版社,2017:29-36.
[6] Hayeck T. Retrospective mixed model and Propensity Score methods for case control data[D]. Harvard:Harvard University, 2015.
[7]孙婷,秦国友,武振宇,等.不同混杂结构条件下各倾向性评分方法的模拟比较研究[J].中国卫生统计,2017,34(3):415-420.
[8] David EA, Cooke DT, Chen Y, et al. Surgery in high-volume hospitals not commission on cancer accreditation leads to increased cancer-specific survival for early-stage lung cancer[J]. The American Journal of Surgery, 2015, 210(4):643-647.
[9] Riquet M, Mordant P, Pricopi C, et al. A review of 250 ten-year survivors after pneumonectomy for non-small-cell lung cancer[J].European Journal of Cardio-Thoracic Surgery:Official Journal of the European Association for Cardio-Thoracic Surgery, 2014, 45(5):876-881.
[10] Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016[J]. CA-A Cancer Journal for Clinicians, 2016, 66(1):7-30.
[11] Zeng H, Chen W, Zheng R, et al. Changing cancer survival in China during 2003-15:a pooled analysis of 17 population-based cancer registries[J]. The Lancet Global Health, 2018, 6(5):e555-e567.
[12] Gu DF, Kelly TN, Wu XG, et al. Mortality attributable to smoking in China[J]. New England Journal of Medicine, 2009, 360(2):150-159.
[13] Islami F, Chen W, Yu XQ, et al. Cancer deaths and cases attributable to lifestyle factors and infections in China, 2013[J]. Annals of Oncology, 2017, 28(10):2567-2574.
[14]张淑娟,常建华,王磊,等.中国新疆维吾尔族人群中肺癌驱动基因的表达[J].中国癌症杂志,2017,27(1):14-19.
[15]刘翔,王秀梅,刘新亚,等.2010年-2014年新疆某院不同民族恶性肿瘤住院病例分析[J].中国病案,2016,17(11):63-65, 96.
[16] Cronin KA, Lake AJ, Scott S, et al. Annual report to the nation on the status of cancer, part I:National cancer statistics[J]. Cancer, 2018,124(13):2785-2800.
[17]陈万青,左婷婷,郑荣寿,等.2013年中国肺癌发病与死亡分析[J].中华肿瘤杂志,2017,39(10):795-800.
[18]张敏璐,吴春晓,龚杨明,等.上海人群肺癌生存率分析[J].中国癌症杂志,2017,27(5):326-333.
[19]郭兰伟,刘曙正,张韶凯,等.中国人群BMI与肺癌发病风险的Meta分析[J].中华预防医学杂志,2015,49(7):649-653.
[20]张翠敏,朱贵东,李全林,等.肺癌生存者生活质量及影响因素分析[J].现代预防医学,2011,38(7):1204-1206.
[21]王丽萍,王剑英,聂芳,等.姑息性化疗对Ⅳ期非小细胞肺癌预后及生存质量的改善作用[J].实用癌症杂志,2018,33(1):63-65.
[22] Drake JA, Portnoy DC, Tauer K, et al. Adding radiation to adjuvant chemotherapy does not improve survival of patients with N2 lung cancer[J]. The Annals of Thoracic Surgery, 2018, 106(4):959-965.
[23]阚强波,王俊峰.手术治疗非小细胞肺癌预后多因素分析[J].实用癌症杂志,2018,33(1):75-78.
[24]李星凯,刘战业,姜运峰,等.原发性中央型和周围型肺鳞癌临床病理学及预后差异[J].山东大学学报(医学版),2017,55(9):73-78.